Said Alfred M, Balamoun Hany A
Department of Anesthesiology, Ain Shams University, Cairo, Egypt.
Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
Obes Surg. 2017 Oct;27(10):2575-2582. doi: 10.1007/s11695-017-2667-9.
The objective of the present study is to evaluate postoperative analgesic outcome of the continuous bilateral transversus abdominis plane (TAP) block using bupivacaine infusion through an epidural catheter inserted through laparoscopic ports.
Ninety patients assigned for laparoscopic sleeve gastrectomy (LSG) were divided into two equal groups according to postoperative analgesia: Control group received IV morphine, and TAP group received bupivacaine 0.25% continuous infusion TAP block through epidural catheters introduced through laparoscopic ports, grasped, and inserted in laparoscopically prepared TAP. Catheters were removed 24 h postoperatively. Frequency and severity of postoperative pain were assessed using numeric rating scale (NRS). Cumulative pain score, number of requests, and total dose of administered rescue analgesia were recorded.
Pain scores were significantly lower throughout 24 h postoperative with a significantly lower cumulative score in the TAP group compared to the control group. Twenty-four patients in the TAP group did not require rescue analgesia, and 17 patients required it once with a significantly higher frequency of patients having a higher number of rescue analgesia requests in the control group. The mean of number of patients requested rescue analgesia; the number of requested doses and total dose of morphine received was significantly lower in the TAP group. Mean time till first ambulation and oral intake was significantly shorter, and morphine-related side effects were significantly lower in the TAP group. Total and differential satisfaction scores were significantly higher in the TAP group.
Continuous bupivacaine TAP block provided through an epidural catheter passed through laparoscopic ports improved postoperative outcome of LSG in terms of reduced postoperative pain scores, sparing morphine consumption, and early recovery items.
本研究的目的是评估通过腹腔镜端口插入的硬膜外导管输注布比卡因进行连续双侧腹横肌平面（TAP）阻滞的术后镇痛效果。
将90例拟行腹腔镜袖状胃切除术（LSG）的患者根据术后镇痛方法分为两组，每组45例。对照组接受静脉注射吗啡，TAP组通过经腹腔镜端口插入、抓取并插入腹腔镜下制备的TAP的硬膜外导管给予0.25%布比卡因持续输注TAP阻滞。术后24小时拔除导管。使用数字评分量表（NRS）评估术后疼痛的频率和严重程度。记录累积疼痛评分、镇痛需求次数和给予的补救镇痛总剂量。
术后24小时内，TAP组的疼痛评分显著低于对照组，累积评分也显著更低。TAP组有24例患者不需要补救镇痛，17例患者仅需一次补救镇痛，而对照组需要补救镇痛的患者数量更多，且需求次数更高。TAP组患者的补救镇痛需求次数、吗啡给药剂量和总剂量的平均值均显著更低。TAP组首次下床活动和经口进食的平均时间显著更短，与吗啡相关的副作用也显著更少。TAP组的总体满意度和差异满意度评分均显著更高。
通过经腹腔镜端口的硬膜外导管进行持续布比卡因TAP阻滞，在降低术后疼痛评分、减少吗啡用量和促进早期恢复方面改善了LSG的术后效果。
